OP30.06: Interest of pelvic magnetic resonance imaging for the pre therapeutic evaluation of symptomatic uterine fibroids: evaluation in 68 cases

To determine the interest of a systematic pelvic MRI examination for symptomatic fibroids treatment. The patients with uterine fibroids and requesting conservative treatment were retrospectively included between October 2007 and February 2008. They all benefited ultrasound scanning (US) and pelvic MRI analysis. Therapeutic strategies based upon a unique ultrasound examination were compared with therapeutic strategies proposed after MRI examination. Sixty eight patients were included. The size of the larger myoma was not significantly different between US and MRI examination. Submucosal myomas were described only with MRI for 9 cases out of 13, and 5 myomas out of 9 classified with US as submucosal were interstitial at MRI. Adenomyosis was only described at MRI in 17 cases out of a total of 18, the existence of a hydrosalpinx in 2 out of 3, endometriosis in 1 case. Therapeutic strategy was modified after MRI examination for 28% of the patients (28.6% if first strategy based upon US was hysteroscopy, 50% for laparoscopy, 21.4% for laparotomy, 38.9% for UAE, only 5.6% if first strategy was hysterectomy as unique possible approach). MRI examination improves the quality of pretherapeutic mapping in cases of uterine fibroids, especially for the evaluation of submucosal fibroids, and improves the rate of associated pathology diagnosis. MRI showed no interest when hysterectomy appeared to be the unique solution after US.